Surgical Technology Application

The first year of Surgical Technology courses concentrates on the completion of required general education
courses. Year two (beginning in July) concentrates on core SURG courses. Please refer to the Vincennes
University catalog for admission criteria and course curriculum.

Compliance with all criteria does not guarantee acceptance. See catalog for complete admission requirements.

→ Personal Information

*Legal First Name

Legal Middle Name

*Legal Last Name

Former Last Name (if applicable)

*Birthdate

*Phone #

*Email Address

*Please Pick 1 Unique Identification # to Enter

Student ID # (A#)

Social Security Number (SSN)

*Student ID # (A#)

*Social Security # (SSN)

→ Other Information

If you completed a GED, please type the code A04202 in the High School Name field
If you attended an International HS, please type the code A00026 in the High School Name field
If you attended a Homeschool, please type the code 970000 in the High School Name field

HS CEEB Code

*High School Name

*Year of HS Graduation

*Have you attended colleges other than VU? Please note this includes colleges/universities you may have received dual credits from while in High School

Yes

No

*If yes, please list all colleges/universities below:

*Please Note: Official Transcripts must be on file at Vincennes University in order for your application to be evaluated*

Do you have any additional comments/information you would like to include?:

→ Final Student Checklist (Do Not Submit Until All Items Checked)

HS Transcript or GED sent to Vincennes Univeristy

Send in College/University Transcripts

Completed Accuplacer Test? (or have other alternate test scores on file?)

*Signature

Date

By signing/typing your name above, you affirm that the information on this application is correct. Falsification of your application may result in your denial of admission to the College of Health Science and Human Performance and/or Vincennes University.

→ Required General Education

• BIOL 111 - Anatomy and Physiology I - 3 hrs -and- BIOL 111L - Anatomy and Physiology Laboratory I - 1 hr -OR- BIOL 107 - Essentials of Human Anatomy and Physiology - 3 hrs -and- BIOL 107L - Essentials of Human Anatomy and Physiology Laboratory- 1 hr
• COMM 143 - Speech - 3 hrs -OR- COMM 148 - Interpersonal Communication - 3 hrs
• ENGL 101 - English Composition I - 3 hrs
• HIMT 110 - Medical Terminology for Allied Health 3 hrs
• MATT 107 - Applied Mathematics - 3 hrs -OR- MATT 109 - Business Mathematics - 3 hrs, ORhigher Mathematics (MATH or MATT) Elective - 3 hrs
• ENGL 102 - English Composition II - 3 hrs -OR- ENGL 205 - Business Communications - 3 hrs
• Humanities, Mathematics, Science, Social Science, Writing, or Fitness/Wellness elective - 5 hrs (Must include BIOL 112/BIOL 112L if BIOL 111/BIOL 111L was taken)
• Social Science Elective - 3 hrs
• Directed Elective - 3 hrs